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People who cut out saturated fatty acids while upping their intake of white bread, pasta and other refined carbohydrates that can cause blood sugar to spike aren’t doing their heart any favors, new research from Denmark shows.

But reducing saturated fatty acid intake while eating more whole grain bread, vegetables (aside from potatoes), and other carbohydrates with a less dramatic effect on blood sugar may improve heart health, Dr. Marianne U. Jakobsen of Aarhus University Hospital and her colleagues found. “The type of carbohydrate matters,” Jakobsen told Reuters Health.

A recent analysis of 21 studies including 350,000 people found “no significant evidence” that saturated fat in and of itself increased heart disease risk, but the authors of that analysis suggested that what people replaced those saturated fat calories with might be more important. A subsequent study found that this was indeed the case; people who upped their polyunsaturated fatty acid intake while cutting saturated fat showed improved heart health.

In the current study, Jakobsen and her team looked at the carbohydrate side of the equation. Specifically, they accounted for the “glycemic index” of different types of carbohydrates.

Glycemic index is a measure of how quickly blood sugar jumps after eating a particular type of carbohydrate. Low glycemic index foods tend to be high in fiber and less refined, such as foods made from whole grains; high glycemic foods are often lower in fiber and more highly refined, and include white bread, pasta made from white flour, and bananas.

To investigate how increasing carb intake while reducing saturated fatty acid intake affected the heart, the researchers looked at 53,644 men and women who had never suffered heart attacks. During follow-up, which averaged about 12 years, nearly 2,000 heart attacks were documented.

Jakobsen and her team divided the study participants into three groups based on the average glycemic index of the carbohydrates in their diet, and then calculated heart attack risk based on the composition of their diet.

They found that heart attack risk fell by 12 percent for every additional 5 percent of a person’s total calorie intake that came from carbohydrates — if a person’s average dietary glycemic index was low. However, this reduction wasn’t statistically significant, meaning it could have been due to chance.

But among the people with the highest average dietary glycemic index, every 5 percent increase in carbohydrate calories upped heart attack risk by 33 percent. For people whose average glycemic index fell in the middle, an increase in carb intake along with a reduction in saturated fatty acid intake had no effect on heart risk.

“We cannot say that saturated fatty acids are not associated with increased risk of coronary heart disease because it depends on what you compare,” Jakobsen told Reuters Health.

Unfortunately, she added, figuring out the glycemic index of a particular food is not straightforward. “It’s a scientific way of classifying foods, so it’s not really public-health-friendly,” she said.

Nevertheless, the researcher added, people can likely decrease their glycemic index by eating “less refined foods.”

SOURCE: American Journal of Clinical Nutrition.

A routine screening test for several metabolic and genetic disorders in newborns, the heel-stick procedure, is not effective in screening for cytomegalovirus (CMV) infection, a leading cause of hearing loss in children, according to research published in the April 14 online issue of the Journal of the American Medical Association.

About 20,000-30,000 infants are born infected with CMV each year, 10-15 percent of whom are at risk for eventually developing hearing loss.

The study, funded by the National Institute on Deafness and Other Communication Disorders (NIDCD), one of the National Institutes of Health, is part of a multicenter research project headed by the University of Alabama at Birmingham that is seeking to find the most effective screening test for CMV infection in newborns. The standard method for detecting CMV infection in newborns is labor-intensive and not conducive to a widespread screening program.

“The heel-stick test is a simple test that is already being used to screen for other diseases in newborns across the United States, so it seemed like a good candidate for a possible universal screening program for CMV,” said James F. Battey, Jr., M.D., Ph.D., director of the NIDCD. “However, these findings show us that, at least with current technologies, the heel-stick test should not be used as a primary newborn screening tool for CMV.”

CMV is the most common infection passed from a mother to her unborn child. The vast majority of CMV-infected babies show no initial symptoms, and many babies will never develop health problems. But in some CMV-infected babies, serious problems can develop over time. Hearing loss is the most common deficit to emerge later on. The earlier doctors can identify CMV infection, the better they can monitor a child’s hearing. If signs of hearing loss are present, appropriate intervention should be provided as soon as possible.

Between March 2007 and May 2008, the researchers analyzed dried blood samples obtained using the heel-stick procedure from babies born at the University of Alabama at Birmingham, and six other participating medical centers across the United States. The heel-stick procedure involves pricking a newborn’s heel, drawing a small amount of blood, and placing the blood on filter paper to dry so that it can be analyzed for several diseases, including hypothyroidism and sickle cell disease.

To test for CMV infection, the researchers removed the babies’ DNA from the filter paper and then used a common molecular diagnostic technique to quickly and efficiently detect whether any CMV DNA was mixed in. The procedure, called real-time polymerase chain reaction, or PCR, uses special molecules, called primers, to seek out a tell-tale portion of CMV DNA and churn out lots of fluorescent copies of that segment so it can be easily detected. For the initial group of babies, the researchers used a single set of primers targeting one section of CMV DNA. As the study progressed, they added a second primer set targeting an additional section in hopes of increasing accuracy, or sensitivity, of the test.

The team also compared their results to the standard method of detecting CMV in newborns. CMV rapid culture is a highly effective procedure that uses saliva or urine instead of dried blood samples to make the identification. The rapid culture method is labor-intensive and requires a tissue culture facility on site, so it would be difficult to adapt this technology to a widespread screening program.

Many studies have found that dried blood spot PCR is able to identify babies with congenital CMV infection, so some researchers have suggested that it be used for a universal screening program. However, none of the earlier studies compared dried blood spot PCR results to the rapid culture method and therefore could not determine if the PCR procedure was as good as the standard or if it fell short and missed truly infected babies or falsely identified babies as being CMV-infected when they were not infected.

In this study, 20,448 babies were screened, 92 of whom were confirmed to have congenital CMV infection. The rapid culture method identified 91 of the 92 infants, for nearly 100 percent sensitivity. For the 11,422 infants who were screened with the single-primer PCR assay derived from dried blood spots, only 17 out of 60 infected children were identified, a 28.3 percent sensitivity. Of the 9,026 infants who were screened with the two-primer PCR method, 11 out of 32 infected children were identified, a sensitivity of 34.4 percent.

“In order to be included as part of a screening test, the minimum sensitivity should be at least 95 percent,” said Suresh Boppana, M.D., a co-principal investigator on the study with Karen Fowler, Ph.D., both of whom are with the University of Alabama at Birmingham. “Our findings indicate that dried blood spot PCR will only detect 30-40 percent of babies with CMV infection. More than half of babies who are infected would be missed.”

The researchers are now assessing whether analysis of saliva samples using real-time PCR technology can do a better job than dried blood spots when compared with the rapid culture method. They believe that the use of saliva may be beneficial since babies with congenital CMV infection are known to have a lot of virus in their saliva, compared to the blood, where amounts can vary depending on when the infant was infected during development. In addition, saliva samples require minimal processing and are noninvasive.

Other participating institutions are Saint Peter’s University Hospital, New Brunswick, N.J.; University of Mississippi Medical Center, Jackson; Carolinas Medical Center, Charlotte, N.C.; University of Pittsburgh and the Children’s Hospital of Pittsburgh; University of Texas Southwestern Medical Center, Dallas; and University of Cincinnati and Cincinnati Children’s Hospital Medical Center.

U.S. hospitals are making little progress in eliminating infections that can harm or kill patients, according to reports released April 13 by the federal Agency for Healthcare Research and Quality.

The 2009 National Healthcare Quality Report and the National Healthcare Disparities Report track contains information on infection rates for 2007, the latest year data has been available.

Researchers found that rates of bloodstream infections after operations (postoperative sepsis) increased by 8 percent, rates of catheter-associated urinary tract infections following surgery increased by 3.6 percent, and rates of certain infections due to medical care increased by 1.6 percent. However, rates of pneumonia that developed after surgery (postoperative pneumonia) fell by 12 percent.

There was no change in the rate of bloodstream infections associated with central venous catheter placements. These are tubes placed in a large vein in a patient’s neck, chest or groin to give medication or fluids, or to collect blood samples.

The reports also found that blacks, Hispanics, Asians, and American Indian patients were less likely than whites to receive preventive antibiotics before surgery in a timely manner.

In an effort to reduce infections associated with healthcare, the AHRQ last year announced funding for nationwide implementation of a program used by more than 100 hospitals in Michigan that cut rates of central line-associated bloodstream infections to near zero.

The AHRQ reports include data on more than 200 health care measures categorized in four areas of quality: effectiveness, patient safety, timeliness, and patient-centeredness.

“Despite promising improvements in a few areas of health care, we are not achieving the more substantial strides that are needed to address persistent gaps in quality and access,” ARHQ Director Dr. Carolyn M. Clancy, said in an agency news release.

Among the other findings from the reports:
One-third of obese adults have never received exercise advice from a doctor.
Obese adults who are black, Hispanic, poor or have less than a high school education are less likely to receive diet advice from a doctor.
One-third of obese adults and most overweight children have not been told by their doctor that they have a weight problem.
Most American children have never received exercise counseling from a doctor and nearly half have never received counseling about healthy eating.

The reports also found that improvements in health care quality and reduction of disparities are slowed by lack of health insurance. For many health services, having no insurance is the single strongest predictor of poor quality care — stronger than race, ethnicity, income or education.

People with no insurance are much less likely than those with private insurance to receive recommended care, especially preventive services and management for diabetes. In the past decade, insurance coverage differences between blacks and whites have narrowed but there are still large disparities related to ethnicity, income and education, the reports said.

SOURCE: U.S. Agency for Healthcare Research and Quality, news release

Walking for 45 minutes a few times a week may help women in the “battle of the bulge” that often accompanies menopause, and at the same time improve overall well being, hints new research from Canada.

Pointing out that the 45 minutes can be broken up into shorter jaunts, researcher Dr. Pascale Mauriège, of Quebec’s Laval University, told Reuters Health in an email it’s a program that could be “easily incorporated” into a woman’s daily life.

The researchers wanted to know if a 16-week walking program would help older overweight inactive women lose some weight, increase their lean body mass and experience a better health-related quality of life.

They enrolled 35 moderately obese and sedentary white women who were either nearing menopause or newly post-menopausal. Thirty women finished the program – 16 premenopausal and 14 postmenopausal.

The women, guided by trainers, walked for 45 minutes on an indoor track every other day for 16 weeks. The intensity of the walking was not unlike the intensity of walking a dog, Mauriège said. While moderately obese, all participants were healthy.

Of the five participants who dropped out of the study early, three bristled at the program’s restrictions and wanted to walk more than three days a week.

At the beginning of the study, post and premenopausal women tended to have similar health-related quality of life ratings on such things as body pain, health, vitality, physical and social functioning and emotional and mental health.

At the end of the program, both groups of women appeared to benefit physically and mentally although in different ways, the researchers report in the journal Menopause.

Greater weight loss was achieved by the premenopausal women who lost an average of about 4.4 pounds compared to 1.5 pounds for the postmenopausal women. They also tended to lose more fat mass. Postmenopausal women, however, tended to benefit with a larger drop in their waist size and from gains in lean body mass.

The program also appeared to have a “non-negligible impact” on both groups’ sense of physical and mental well being, the researchers report.

Postmenopausal women had the larger gains in health-related quality of life scores in bodily pain, daily physical functioning, general health, emotional and mental health while premenopausal women had the greater gains in all physical activities of life, vitality and social functioning.

Mauriège said, to her knowledge, this is the first study to test the impact of a walking program on the various mental functioning scores in pre- and postmenopausal women.

But the study’s small size and lack of a control group (a group of women similar to participants who did not take part in the study’s exercise regimen) limits the validity of the findings.

Still, the findings do suggest that “moderate-intensity and moderate-frequency exercise” easily integrated in life habits seems to be enough to improve health-related quality of life in both premenopausal and early postmenopausal women, the researchers conclude.